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Doppler and M-Mode Ultrasonography to Time Fetal Atrial and Ventricular Contractions

From the Fetal Cardiology Unit, Pediatric Cardiology Division, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Canada.

Address reprint requests to: Jean-Claude Fouron, MD Saint Justine Hospital Fetal Cardiology Unit 3175, Cote Ste. Catherine Montreal, Quebec H3T 1C5 Canada E-mail: fouron{at}sympatico.ca

Objective: To compare ease of recording and reliability of ultrasonographic approaches used to time fetal heart atrial and ventricular contractions.

Methods: Seventeen consecutive fetuses seen at our fetal cardiology unit for possible fetal cardiac arrhythmia were included in this study. The same ultrasonographer obtained M-mode tracings of atrial and ventricular free walls, atrial wall and opening of the aortic valves, a peak of the mitral valve, and the opening of the aortic valves; and Doppler signals of flow-velocity waveforms in the outflow tract of the left ventricle and simultaneous flow-velocity waveforms in the aorta and superior vena cava. The outcome measures were rate of successful attempts and intra- and interobserver reliability coefficients.

Results: Valid recordings were made for all patients with one M-mode (atrial and ventricular free walls) and two Doppler (intraventricular, superior vena cava, and ascending aorta) approaches. Atrioventricular intervals were significantly longer with M-mode compared with Doppler ultrasonography. Reliability coefficients were excellent (at least 0.89) for all intraobserver measurements. Comparisons of atrioventricular and ventriculoatrial interval measurements made by two observers gave the following intraclass correlation coefficients (95% confidence interval): atrioventricular = M-mode: 0.87 (0.79, 0.91), left ventricular outflow: 0.93 (0.89, 0.96), superior vena cava–aorta: 0.98 (0.97, 0.99); ventriculoatrial = M-mode: 0.79 (0.67, 0.87), left ventricular outflow: 0.97 (0.95, 0.98); superior vena cava–aorta: 0.99 (0.98, 0.99).

Conclusion: Fetal atrioventricular intervals measured indirectly from M-mode or Doppler tracings were equally reliable when measured by the same observer; the Doppler approaches had better correlation between measurements made by two different observers.

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